突發(fā)公共衛(wèi)生事件中的人道主義醫(yī)藥物資分配
本文選題:人道主義物流 + 應(yīng)急物流; 參考:《浙江大學(xué)》2016年博士論文
【摘要】:突發(fā)公共衛(wèi)生事件不僅危害人民身體健康、導(dǎo)致經(jīng)濟(jì)損失,還會(huì)對人們造成短期和長期的心理傷害。如何提供可靠、有效、公平的人道主義醫(yī)藥物流至關(guān)重要。本文聚焦于突發(fā)公共衛(wèi)生事件,尤其是大規(guī)模傳染病爆發(fā)的情境。在闡述人道主義醫(yī)藥物資分配的重要作用、特殊之處和研究價(jià)值的基礎(chǔ)上,本文綜合分析傳染病爆發(fā)后的應(yīng)急物資分配問題,兼顧物資分配的效率性與公平性,建立和求解人道主義醫(yī)藥物資分配模型,以降低突發(fā)公共衛(wèi)生事件造成的損失與傷害。具體而言,本文的主要內(nèi)容包括:(1)人道主義醫(yī)藥物資的單地區(qū)動(dòng)態(tài)分配模型。在需求不確定的環(huán)境下,討論醫(yī)藥物資在時(shí)間軸上的分配問題。突發(fā)公共衛(wèi)生事件通常會(huì)持續(xù)一段時(shí)間,并且出于人道主義的原因,某一地區(qū)的剩余物資可能會(huì)由上級政府進(jìn)行統(tǒng)一的二次分配而供其它地區(qū)使用。因此,一個(gè)地區(qū)的決策者不能只考慮單一階段的物資需求,還需要考慮本地物資庫存與消耗的動(dòng)態(tài)變化。本文根據(jù)傳染病的特點(diǎn),采用動(dòng)態(tài)隨機(jī)規(guī)劃方法建立模型。每個(gè)時(shí)間階段的初始庫存大小會(huì)受到之前階段的物資分配量與隨機(jī)需求量的影響,而醫(yī)藥物資的隨機(jī)需求的分布函數(shù)也隨時(shí)間變化。在這一部分也對如何具體化醫(yī)藥物資需求的概率密度函數(shù)和累積分布函數(shù)進(jìn)行了說明。此外,本文也建立了一個(gè)相應(yīng)的靜態(tài)隨機(jī)規(guī)劃模型,用以比較靜態(tài)模型和動(dòng)態(tài)模型的異同。在建模的基礎(chǔ)上,本章給出了最優(yōu)解的解析形式,并對其性質(zhì)加以分析。最后,采用數(shù)值分析進(jìn)一步理解其在管理實(shí)踐上的價(jià)值。(2)人道主義醫(yī)藥物資的多地區(qū)分配模型。在假設(shè)需求可以預(yù)測的基礎(chǔ)上,提出了一個(gè)多地區(qū)的物資分配的基本模型。該模型包括往復(fù)進(jìn)行的兩個(gè)部分:(a)隨時(shí)間變化的醫(yī)藥物資需求的預(yù)測。本文根據(jù)傳染病的傳播規(guī)律,提出了一個(gè)經(jīng)過修正的易感-潛伏-傳染-治愈(SEIR)模型來預(yù)測每個(gè)疫區(qū)的醫(yī)藥物資需求?紤]到脆弱型人群的傳染率、死亡率、治愈率通常與普通型人群不同,模型充分體現(xiàn)了脆弱型人群和普通型人群之間的差異,提高了預(yù)測的準(zhǔn)確率。(b)物資分配決策。根據(jù)需求預(yù)測的結(jié)果,建立線性規(guī)劃模型,將其應(yīng)用于多出救點(diǎn)、多需求地的物資分配問題。在此基礎(chǔ)上,本文又提出兩個(gè)擴(kuò)展模型,以增強(qiáng)模型解決實(shí)際問題的能力。本文首先擴(kuò)展需求預(yù)測部分,考慮多個(gè)疫區(qū)之間的空間交互關(guān)系。其次,通過討論受影響人群的心理狀態(tài)對分配決策進(jìn)行擴(kuò)展。最后,本文通過一個(gè)基于真實(shí)數(shù)據(jù)的案例研究和四個(gè)基于實(shí)驗(yàn)數(shù)據(jù)的測試分析,對三個(gè)模型進(jìn)行比較。數(shù)值分析的結(jié)果說明了模型的可行性和三個(gè)模型之間的異同,對管理實(shí)踐具有借鑒意義。(3)人道主義醫(yī)藥物資分配中的跨部門合作。研究物資配置中的跨部門合作與信息共享問題。典型的人道主義物流活動(dòng)中的參與部門可以分為兩類:公共部門(例如政府部門)和私人部門(例如企業(yè))。本文構(gòu)建了四種不同合作機(jī)制下的隨機(jī)規(guī)劃模型,分別是:非合作模型、由政府部門領(lǐng)導(dǎo)的半合作模型、由私人部門領(lǐng)導(dǎo)的半合作模型,以及完全合作模型。在半合作策略下,兩個(gè)部門能夠共享關(guān)于目標(biāo)和約束的相關(guān)信息,但各自分別做出物流決策;而在完全合作策略下,政府部門制定決策,但需要向私人部門支付一定補(bǔ)貼以維持合作關(guān)系。在建立模型的基礎(chǔ)上,本文分別求出了四種模型的最優(yōu)解的解析表達(dá)式、討論這四種模型的異同,并進(jìn)一步進(jìn)行數(shù)值分析。解析分析和數(shù)值分析結(jié)果說明了半合作與完全合作機(jī)制分別的潛在優(yōu)勢。本文的重要貢獻(xiàn)和創(chuàng)新點(diǎn)包括:(1)開展跨學(xué)科的研究,綜合應(yīng)用多種理論和方法,形成比較完整、具有針對性的大規(guī)模突發(fā)公共衛(wèi)生事件中的人道主義醫(yī)藥物資分配決策模型。(2)在研究物資在時(shí)間軸上的動(dòng)態(tài)分配問題時(shí),建立動(dòng)態(tài)隨機(jī)規(guī)劃模型并求得其解析和數(shù)值解。建立的模型更符合實(shí)際,其最優(yōu)解的解析形式為實(shí)現(xiàn)物資的最優(yōu)配置提供決策依據(jù)。(3)在預(yù)測需求時(shí),充分考慮傳染病疫情的演化過程和發(fā)展規(guī)律,并進(jìn)一步考慮到脆弱型人群的特殊生理特質(zhì)和疫區(qū)之間的空間互動(dòng)關(guān)系,為物資分配決策提供依據(jù)。(4)提出決策目標(biāo)時(shí),不僅考慮疫區(qū)居民的生理狀態(tài)和物資分配的成本,也討論疫區(qū)居民心理情況,以優(yōu)化生理和心理狀態(tài),而不是僅僅物資最多或效率最高為分配決策的目標(biāo),更體現(xiàn)人道主義救援中以人為本的特征。(5)研究公共部門與非公共部門合作開展人道主義物資分配的可能性與合作模式,并對不同的模式進(jìn)行比較。
[Abstract]:Public health emergencies not only harm the health of the people, cause economic losses, but also cause short-term and long-term psychological harm to people. How to provide reliable, effective and fair humanitarian medical logistics is very important. This article focuses on public health emergencies, especially the situation of the outbreak of large-scale infectious diseases. On the basis of the important role, particularity and research value of the distribution of medical materials, this paper comprehensively analyzes the problem of the distribution of emergency materials after the outbreak of infectious diseases, takes into account the efficiency and fairness of material distribution, establishes and solves the distribution model of humanitarian medical materials, so as to reduce the loss and injury caused by the emergency public health events. The main contents of this paper are as follows: (1) a single area dynamic distribution model of humanitarian medical materials. The distribution of medical materials on the timeline is discussed under the uncertainty of demand. Public health emergencies usually last for a period of time, and for reasons of humanitarianism, the surplus material in a certain area may be possible. There will be a unified two allocation by the superior government for use in other areas. Therefore, the decision-makers in a region can not only consider the material needs of a single stage, but also consider the dynamic changes in the inventory and consumption of local materials. Based on the characteristics of infectious diseases, the dynamic random planning method is used to establish the model. The initial stock size will be influenced by the distribution of material and the random demand in the previous stage, and the distribution function of the medical materials' random demand varies with time. In this part, the probability density function and the cumulative distribution function of the medical material demand are explained. The static stochastic programming model is used to compare the similarities and differences between the static model and the dynamic model. On the basis of the modeling, the analytic form of the optimal solution is given and its properties are analyzed. Finally, the value of its management practice is further understood by the numerical analysis. (2) the multi regional distribution model of humanitarian medical materials is assumed. On the basis of the demand prediction, a basic model of material distribution in a multi region is proposed. This model includes two parts of the reciprocation: (a) the prediction of the demand for medical materials with time. In this paper, a modified susceptibility latent infection cure (SEIR) model is proposed to predict each of the spread of infectious diseases. Considering the infection rate, death rate and cure rate of the vulnerable population, the rate of cure is usually different from that of the ordinary people. The model fully embodies the difference between the vulnerable group and the common type, and improves the accuracy of the forecast. (b) the decision of material distribution. The linear programming model is set up according to the result of the demand forecast. On the basis of this, two extended models are proposed to enhance the ability of the model to solve practical problems. In this paper, we first extend the demand prediction part and consider the spatial interaction between the multiple epidemic areas. Secondly, the allocation decision is discussed by discussing the psychological state of the affected population. In the end, this paper compares the three models with a case study based on real data and four tests based on experimental data. The results of the numerical analysis illustrate the feasibility of the model and the similarities and differences between the three models, and are useful for the management practice. (3) the cross part of the distribution of humanitarian medical materials. Cross sectoral cooperation and information sharing in material allocation. The participating sectors in typical humanitarian logistics activities can be divided into two categories: public sectors (such as government departments) and private sectors (such as enterprises). This paper constructs random programming models under four different cooperative mechanisms, namely, non cooperative models, The semi cooperative model led by the government department, the semi cooperative model led by the private sector, and the complete cooperation model. Under the semi cooperative strategy, the two departments can share the relevant information about the target and the constraints, but each makes the logistics decision respectively. Under the complete cooperation strategy, the government departments make decisions, but need to be directed to the private department. The door pays a certain allowance to maintain the cooperative relationship. On the basis of the establishment of the model, the analytic expression of the optimal solution of the four models is obtained. The similarities and differences of the four models are discussed and the numerical analysis is further carried out. The analytical and numerical results show the potential advantages of the semi cooperative and complete cooperation mechanism respectively. The important contributions and innovation points include: (1) to carry out interdisciplinary research and apply a variety of theories and methods to form a relatively complete and targeted public health emergencies decision-making model for the distribution of humanitarian medical materials. (2) dynamic random planning is established in the study of the dynamic distribution of materials on time and time axis. The model and its numerical solution are obtained. The model established is more practical, and the analytical form of the optimal solution provides the decision basis for the optimal allocation of materials. (3) the evolution and development of infectious diseases are fully considered in the prediction of the demand, and the special physiological characteristics of the vulnerable population and the area between the epidemic areas are further considered. The spatial interaction relationship provides the basis for the decision-making of material distribution. (4) when making the decision goal, not only takes into account the physiological state and the cost of the material distribution of the residents in the epidemic area, but also discusses the psychological situation of the residents in the epidemic area, in order to optimize the physiological and psychological state, not only the maximum material or the highest efficiency is the goal of the allocation decision, but also embodies the humanitarian rescue. (5) study the possibility and mode of cooperation between the public sector and the non public sector to carry out the distribution of humanitarian materials, and compare the different models.
【學(xué)位授予單位】:浙江大學(xué)
【學(xué)位級別】:博士
【學(xué)位授予年份】:2016
【分類號】:R197.1
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